A 25 year perspective on advances in the pathologic assessment and diagnosis of urologic cancers.

Over the past 25 years, diagnostic categories in genitourinary pathology have changed dramatically. Prostate cancer reporting incorporated numerous new variant categories, recognized the importance of intraductal carcinoma, and introduced the concept of Grade Groups. Pathologic diagnosis of bladder cancer not only added new variant categories, but also modified the grading of non-invasive urothelial neoplasms and refined staging definitions. Kidney cancer classification expanded from a handful of diagnostic categories to a broad array of additional cancer types defined by unique immunohistochemical and molecular findings. Segregation of penile carcinoma by human papillomavirus status more accurately reflected pathogenesis and helped improve prediction of cancer behavior. Testicular pathology research advanced understanding of germ cell tumor subtypes and their impact on patient outcomes. Finally, adrenal gland pathology has evolved to incorporate a broader recognition of morphological variation and risk factors associated with tumor progression. Taken together, changes in pathology over the past quarter century have revolutionized our approach to genitourinary cancers. This review seeks to highlight some of the many significant changes in genitourinary pathology that have occurred during the past 25 years and emphasize impacts on clinical outcomes or therapy, as relevant.

A 25-year perspective on the evolution of radiation treatment of urologic cancers.

Advances in radiotherapy technology and technique over the last 3 decades have revolutionized radiation treatment options for genitourinary malignancies. The development of more focused and accurate radiation treatment has facilitated safe delivery of dose-escalated treatment that improves disease control and the development of shorter-duration hypofractionated treatment regimens that are more convenient for patients and improve access to treatment. The management of oligometastatic disease is evolving with ablative treatment of oligometastasis and the primary for select patients and shorter-duration palliative treatment regimens. Work is ongoing to personalize radiation treatment regimens for genitourinary malignancies based on molecular biomarkers.

A 25-year perspective on advances in the study of the epidemiology, disparities, and outcomes of urologic cancers.

In this narrative review, key developments in epidemiologic and clinical outcomes-based research from eminent historical data sources over the past quarter century are summarized. We then describe the rise of secondary and administrative datasets (AD), summarizing the predominant types of available secondary datasets for contemporary research and describe the benefits and inherent limitations in working with secondary data. We review the methodological advances that permit researchers to capitalize on the full capability of secondary data while also addressing the limitations inherent in utilizing these data for the purposes of epidemiologic and outcomes research. Finally, we present candidate strategies to perpetuate this momentum towards optimizing the development of clinical research infrastructure that harnesses the full potential of the ADs to further clinical and epidemiological research, advancing data analysis, and address the many unanswered questions that remain.

Incidence of prostate and urological cancers in England by ethnic group, 2001-2007: a descriptive study.

BACKGROUND: The aetiology of urological cancers is poorly understood and variations in incidence by ethnic group may provide insights into the relative importance of genetic and environmental risk factors. Our objective was to compare the incidence of four urological cancers (kidney, bladder, prostate and testicular) among six 'non-White' ethnic groups in England (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese) to each other and to Whites. METHODS: We obtained Information on ethnicity for all urological cancer registrations from 2001 to 2007 (n = 329,524) by linkage to the Hospital Episodes Statistics database. We calculated incidence rate ratios adjusted for age, sex and income, comparing the six ethnic groups (and combined 'South Asian' and 'Black' groups) to Whites and to each other. RESULTS: There were significant differences in the incidence of all four cancers between the ethnic groups (all p < 0.001). In general, 'non-White' groups had a lower incidence of urological cancers compared to Whites, except prostate cancer, which displayed a higher incidence in Blacks. (IRR 2.55) There was strong evidence of differences in risk between Indians, Pakistanis and Bangladeshis for kidney, bladder and prostate cancer (p < 0.001), and between Black Africans and Black Caribbeans for all four cancers (p < 0.001). CONCLUSIONS: The risk of urological cancers in England varies greatly by ethnicity, including within groups that have traditionally been analysed together (South Asians and Blacks). In general, these differences are not readily explained by known risk factors, although the very high incidence of prostate cancer in both black Africans and Caribbeans suggests increased genetic susceptibility. g.

Treinta años del Grupo de Trabajo de Urología Oncológica de la Asociación Española de Urología (1978-2008) / Thirty years of the Oncological Urology Work Group of the Spanish Association of Urology (1978-2008)

Introducción y objetivos: se cumplió en junio de 2008 el trigésimo aniversario de la creación del Grupo de Trabajo Uro-Oncológico de la Asociación Española de Urología (AEU), en junio de 1978. Revisamos, bajo el punto de vista histórico, las vicisitudes que concurrieron para su constitución, y nos centramos en el papel llevado a cabo por los coordinadores y las actividades mantenidas. Material y métodos: repasamos el reglamento, los programas de sus reuniones anuales y las publicaciones de la AEU desde 1968; analizamos cuántas noticias y referencias aparecen reflejadas sobre el Grupo y recogemos información directa de los coordinadores, además de aportar vivencias personales. Resultados: fue el primer Grupo de Trabajo instituido en el seno de la AEU. Nació como respuesta de la Junta Directiva al clamor de los urólogos que deseaban asociarse para profundizar en el conocimiento del cáncer urológico. En estos 30 años se han realizado25 reuniones dirigidas por 7 coordinadores, quienes se han esforzado en poner al día la patología oncológica y consolidar el grupo. Conclusiones: en su inicio fue la junta directiva la que señaló sus actuaciones; pronto la personalidad de los coordinadores y su calidad científica hizo que marcaran las directrices, en las que el repaso a todos los tumores urológicos, con la puntualización sobre los más candentes y conflictivos en cada momento, constituye el mayor valor de su existencia. La edición de un protocolo diagnóstico y de varios libros sobre cáncer del aparato urinario, el trabajar junto con los oncólogos y abrir líneas de investigación y de estudio han sido las labores más destacables (AU)

Introduction and objectives: June 2008 marked the thirtieth anniversary of the creation of the Oncological Urology Work Group of the AEU in June 1978. A historical review is thus made of the circumstances leading to its creation, with a special focus on the role played by coordinators and the activities carried out. Materials and methods: A review is made of the Group’s rules, the agendas of its annual meetings, and AEU publications since 1968. Any news about and references to the Group included are analyzed, and direct information from coordinators, as well as personal experiences, are provided. Results: The Board of Directors of the AEU created this first Work Group in response to the requests by urologists who wanted to work together to achieve a deeper understanding of urological cancer. Twenty-five meetings directed by seven coordinators who have strived for updating oncological pathology and consolidating the group have been held over these30 years. Conclusions: The Board of Directors initially suggested the Group’s activities, but the personality and scientific quality of the coordinators soon caused them to mark the pace of the work, in which review of all urological tumors, with special emphasis on those of most interest and most controversial at each given point in time, is the primary objective. The most outstanding achievements of the Group have been the publishing of a diagnostic protocol and several books on cancer of the urinary tract, joint work with oncologists, and opening of new research and study lines (AU)

Baltasar Llopis Mínguez (1934-1990). Pionero en la investigación del cáncer vesical y en la introducción de la informática en Urología / Baltasar Llopis Mínguez (1934-1990). A pioneer in research on bladder cancer and introduction of computing in Urology

Objetivo: rememorar la figura de un gran urólogo valenciano, destacar su gran personalidad y humanidad, además de resaltar su importante aportación urológica en el estudio de los factores pronósticos y del cálculo del riesgo oncológico individual, así como introductor de la informática en Urología. Método: repasamos sus trabajos, el testimonio de los compañeros que lo trataron y datos obtenidos de sus familiares directos, además de nuestro conocimiento personal. Resultado: valenciano de nacimiento, licenciado y doctor en Medicina por su Universidad, formado en la especialidad con el Dr. Tramoyeres Cases, de quien fue su ayudante quirúrgico y a quien acompañó en el Hospital de La Fe desde su creación, donde desarrolló toda su actividad urológica. Se decantó por la investigación oncológica, especialmente por el tumor urotelial, en el que fue pionero en el diagnóstico mediante marcadores tumorales, y en el estudio de los factores pronósticos para evaluar el riesgo individual de recidiva y para llevar a cabo un tratamiento quimioterápico específico, los cuales introdujo en la práctica clínica en el Hospital La Fe. Con ello puso de manifiesto las dos vertientes esenciales de su personalidad: la investigadora y la humana. Conclusión: persona polifacética, dotado de grandes aptitudes y una elevada inteligencia, se dedicó con ahínco a la investigación del cáncer para entender su comportamiento biológico, especialmente el del urotelio; pionero mundialmente a principios de los ochenta en el desarrollo de marcadores específicos, de estimaciones de riesgo oncológico individual y de los factores pronósticos para llevar a cabo su tratamiento. Se adelantó en 20 años a la era de los nomogramas predictivos y a su introducción clínica, además de ser un precursor de la aplicación informática en Urología, diseñó una base de datos para el registro del tumor vesical superficial, que le permitió realizar análisis estadísticos y multivariantes con modelos de regresión múltiple para vaticinar el riesgo de recidiva (AU)

Objective: To recall the figure of a great Valencian urologist, to emphasize his great personality and humanity, and to draw particular attention to his significant contribution to the study of prognostic factors in urology and estimation of individual oncological risk, as well as to introduction of computing in urology. Method: His work, the testimony of colleagues who treated him, and data obtained from his close relatives, as well as our own personal knowledge, are reviewed. Result. Baltasar Llopis was born in Valencia, and obtained his degree and doctorate in Medicine at the Valencia University. He specialized in urology with Dr. Tramoyeres Cases, for whom he acted as assistant surgeon and with whom he shared work at La Fe Hospital, where he carried out his complete urological activity, since its inception. Dr. Llopis opted for oncological research, with a special focus on urothelial tumors. He pioneered diagnosis of these tumors using tumor markers and the study of prognostic factors to assess the individual risk of relapse and to implement a specific chemotherapeutic treatment, which he introduced in clinical practice at La Fe Hospital. He thus demonstrated the two essential components of his personality, his investigative and human sides. Conclusion: A multi-faceted person with great skills and intelligence, Dr. Llopis eagerly devoted himself to research aimed at understanding the biological behavior of cancer, particularly urothelial tumors. In the early 80s he pioneered worldwide the development of specific markers, estimations of individual oncological risk, and prognostic factors useful for planning treatment. He was 20 years ahead of the era of predictive nomograms and their clinical introduction. In addition to being a forerunner of computing applications in Urology, he designed a database for registration of superficial bladder tumors, which allowed him to perform statistical and multivariate analyses using multiple regression models to predict the risk of relapse (AU)

The alchemy of jargon: etymologies of urologic neologisms-part 4: the history of histological nomenclature.

BACKGROUND: As the scientific community is increasingly severed from the study of linguistics, the underlying significance of their common technical words is becoming blurred. This article will focus on the genesis of terminology in the field of Histology. METHODS: These notes will give a detailed background of the history of technical terms, including how they came into being, whence they were derived, and how they impacted the scientific community through the ages. RESULTS: In this installment, following terms are analyzed: organ, gland, tissue, membrane, acinus, fibroblast, epithelium, and endothelium. CONCLUSIONS: This analysis of the history and significance of scientific terms common to the urological community works toward a fortification of their power by offering a reminder of their origins.

The alchemy of jargon: Etymologies of urologic neologisms. Number 5: oncology and its vocabulary.

BACKGROUND: As the scientific community is increasingly severed from the study of linguistics, the underlying significance of their common technical words is becoming blurred. This article will focus on the genesis of terminology in the field of Oncology. METHODS: These notes will give a detailed background of the history of technical terms, including how they came into being, whence they were derived, and how they impacted the scientific community through the ages. RESULTS: In this installment, following terms are analyzed: Oncology, Cancer, Carcinoma, Metastasis, Neoplasm, Malignant, and Benign. CONCLUSIONS: This analysis of the history and significance of scientific terms common to the urological community works towards a fortification of their power by offering a reminder of their origins. Prostate 69: 1369-1371, 2009. (c) 2009 Wiley-Liss, Inc.

[Metastases from urologic malignancies: history, definitions and strategies]. / Les métastases des cancers urologiques : historique, définitions et enjeux.

The word metastasis came from grec "I move". Bayle and Récamier were the first to show the relation between a secondary tumor from a primitive carcinoma but it is really Stephen Paget who is the father of the "seed and soil" theory to explain metastasis dissemination. Since, a lot of works have been done to better understand the metastasis physiopathology and in particular Judah Folkman participated very actively in angiogenesis mechanisms research. Today, even if all is not totally understood, physicians know that metastasis is a decisive event in the carcinoma story.